[HISTORY: Adopted by the Mayor and Council of the Borough
of Washington 5-24-1983 by Ord. No. 9-83. Amendments noted where
applicable.]
The purpose of this chapter is to require that a claimant for
damage or injury rising under the New Jersey Tort Claims Act (N.J.S.A.
59:1-1 et seq.) provide certain needed information to the Borough
of Washington in order that the appropriate Borough officials and
the Borough insurance carrier, if any, may receive all necessary information
in order to properly evaluate and dispose of such claims.
A claimant, or some other person acting on behalf of the claimant,
shall file an initial notice of claim for damages against the Borough
of Washington containing all the information required under the provisions
of N.J.S.A. 59:8-4. A copy of the required form specifying information
to be contained in said initial notice of claim for damages is annexed
hereto as Exhibit A and shall be on file at the office of the Borough
Clerk.
A claimant, or some person acting on behalf of such claimant,
shall be required to file a claim for damages against the Borough
of Washington within the time required by the New Jersey Tort Claims
Act.
A.
Said
claim for damages shall contain all of the information required to
be submitted by N.J.S.A. 59:8-4 and, in addition, shall contain the
following additional information:
(1)
Description of accident or occurrence.
(2)
Names and addresses of all witnesses.
(3)
Name and address of the Borough agency or agencies which caused the
damage or injury.
(4)
Name and address of Borough employee or employees claimed to be at
fault.
(5)
A statement of the negligent or wrongful acts of the Borough agency
and/or Borough employees which caused the damage or injury.
(6)
The names of all police officers and police department that investigated
the accident.
(7)
A statement as to whether the claim is for personal injury, property
damage or other.
(8)
If a personal injury claim, a description of the injuries resulting
from the accident or occurrence and whether permanent disability is
claimed.
(9)
If a personal injury is claimed, a listing of the name of each hospital,
doctor or other facility providing examination, treatment or diagnostic
service; the address and the date of treatment or services; the amount
of charges to date; and the amounts paid or payable by other sources
such as insurance.
(10)
If a claim for loss of wages or income is made, the claimant shall
provide the name of the employer, the address, occupation, date of
employment, rate of pay, date of absence from work, total lost wages
up to date and expected date of return. If self-employed, the claimant
shall attach a calculation showing the basis of calculation of lost
income.
(11)
If property damage is claimed, the claimant shall provide a description
of the property; the location of the property and the time when it
may be inspected; date of acquisition of the property at the time
of the accident; a description of the damage; copies of estimates
of repair costs or, if the damage has been repaired, a statement specifying
by whom repairs were made, when and the cost of repairs; and a statement
of the loss claimed by the claimant for property damage.
(12)
A statement in detail by the claimant of all other items of loss
or damages and the method of calculating such loss or damages.
(13)
The amount of the claim.
(14)
Whether the claimant has made a claim against anyone else for any
of the losses or expenses claimed in said notice and, if so, the name
and addresses of all persons and insurance companies against whom
the claimant has made such claims.
(15)
A statement as to whether any of the losses or expenses claimed against
the Borough are covered by any policy of insurance and, if so, a statement
of the name and address of the insurance company, policy number and
benefits paid or payable.
(16)
A statement as to whether the claimant has received or agreed to
receive any money for the damages claimed herein and, if so, a statement
of the details of such agreement.
(17)
The claimant shall be required to submit with the notice of claim
for damage the following:
(a)
Copies of itemized bills for each medical expense and other
losses and expenses claimed.
(b)
Full copies of appraisals and estimates for property damage
claimed.
(c)
Copies of all written reports of all expert witnesses and treating
physicians.
(d)
A letter from the claimant's employer verifying lost wages
or, if self-employed, a statement showing the calculations of claimed
lost income.
(e)
An authorization to all doctors, hospitals or other medical
service facilities to release to the Borough of Washington any and
all records, reports and other information concerning the treatment
of the claimant.
B.
A
copy of the forms specifying the information to be contained in the
claim for damages against the Borough of Washington is annexed hereto
as Exhibit B and shall be on file at the office of the Clerk of the
Borough of Washington.
The aforesaid claim forms shall be signed by the claimant or
by some person on his behalf and shall be filed with the Borough Clerk
of the Borough of Washington at her office located in the Municipal
Building, 100 Belvidere Avenue, Washington, New Jersey 07882.
